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COVENANT PHARMACY LLC
CAH251304-00 TALLAHATCHIE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
TALLAHATCHIE GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251304-00
Entity Address
141 Dr. T.T. Lewis Circle
CHARLESTON, MS 38921
Medicare Provider Number
251304
Participating Start Date
4/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
COVENANT PHARMACY LLC
Pharmacy Address
371A HIGHLAND COLONY PARKWAY
RIDGELAND, MS 39157
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BILLY MARLOW, CEO
(662) 721-7370
Contract Pharmacy Representative
Anna Alman, Manager
(601) 326-5760
Signed By Date
4/9/2014
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